Monthly Archives: July 2015

The number of teenagers with gender dysphoria increased sharply at a Canadian clinic, starting in 2004.

The authors of this article call for more discussion and research on the subject of teenagers with gender dysphoria.

Are the numbers also increasing at clinics in other countries? If so, why?

Since this article was published in 2008, additional studies have suggested that there is indeed an increase in the number of teenagers being treated for gender dysphoria.

We still do not know why.

This graph shows the numbers of cases of gender dysphoria the Canadian clinic saw starting in 1976. * The top line shows cases of children, the bottom line shows cases of teenagers.

“For the adolescents, however, it is apparent that there has been a dramatic increase in referrals starting only in the most recent block, 2004–2007. Prior to this, the number of referred adolescents was comparatively small and always lower than the number of referred children. A line from the 1967 song “For What It’s Worth” by Buffalo Springfield goes: ‘There’s something happening here. What it is ain’t exactly clear’.”

The authors do not know what has caused this increase.

Is something causing more teenagers to develop gender dysphoria?

Or have Internet sites and media coverage made it possible for more teenagers to seek help for gender dysphoria?

And, in either case, have other clinics seen an increase in the number of adolescent patients with gender dysphoria?

We need to know what is going on so that patients can get the best care possible.

“If there is an increase, the importance of articulating the best practice model to care for these children and youth is even more acute (Zucker, in press). We found it curious that Oprah Winfrey chose as the “expert” for her show on transgendered children an M.A. level therapist who acknowledged on the program that she had never worked with a child who had GID. We would hope that all training programs in child and adolescent psychiatry give at least some minimal exposure to residents to basic principles of physical sex differentiation, an overview of normative gender development, review of diagnostic and assessment tools that have been developed for children and adolescents with GID, discussion of various etiological models, and consideration of extant therapeutic approaches. Perhaps one “team” could be assigned to handle referrals of children and adolescents with problems in their gender identity development. The more experience one has with a specific syndrome, the easier it is to appreciate the range in clinical presentation, including the range in associated psychopathology in the child and in the family.

If GID in adolescents is “coming out of the closet,” members of the child and adolescent psychiatry profession, the allied disciplines, and specialists in gender identity issues need to take the lead in providing exemplary care for these children and youth and their families with the same rigor as they do for children and youth with any other clinical problem.”

* Some patients who were assessed were excluded from these numbers: “We excluded children referred for fetishistic cross-dressing and we excluded referred adolescents who were diagnosed with transvestic fetishism (without co-occurring gender dysphoria), gay youth, and youth who were ‘undifferentiated.'”

A few notes:

1) If you’re wondering about the increases in the numbers of children referred to the clinic, the authors suggest this might have been related to changes in the 1987 Diagnostic and Statistical Manual of Mental Disorders (DSM). In that version of the DSM, the section on childhood gender dysphoria was moved to the section for conditions “Usually First Diagnosed in Infancy, Childhood, or Adolescence.” This might have brought it to the attention of medical professionals who treat children.

2) The authors point out that the media began talking about transgender children in the early 21st century. Oprah Winfrey had a show on the subject in 2004 and 20/20 had a similar one in 2007.

However, as they also point out, the media attention did not seem to cause a change in the numbers of children referred to their clinic.

Internet sites, however, might affect teenagers more than children.

3) The article does not give the name of the clinic. Based on the authors, it is in Toronto.